Comparing Patient Outcomes Of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement

Abstract

Background: Aortic stenosis (AS) is a valvular heart disease that predominantly affects older adults. Valve replacement is the treatment of choice for severe symptomatic AS. However, some older adults cannot undergo open surgical aortic valve replacement (SAVR) due to their higher risk for complications. Over the past decade, transcatheter aortic valve implantation (TAVI) has emerged as the recommended therapy for selected high surgical risk patients and was proven to be non-inferior to SAVR in intermediate and low risk patients.

Aims: The aims of the study were to investigate the outcomes of patients who underwent aortic valve replacement (in hospital and 30-day mortality, length of stay and short-term complications including infection and bleeding); and compare these outcomes in SAVR versus TAVI patients within all risk score categories.

Method: A retrospective review of 240 consecutive medical charts who underwent SAVR and TAVI at the American University of Beirut Medical Center was conducted to collect relevant data. Univariate descriptive statistics, bivariate correlational analyses, and multiple logistic regression analyses were performed to describe the sample, the study outcomes, and examine predictors of in-hospital and 30 day complications. The approval of the Institutional Review Board at the American University of Beirut was obtained prior to data collection. Results: The mean age of the entire sample (N=240) was 79.49 (standard deviation [SD] = 5.76), with the SAVR population being significantly younger (77.14 ± 4.65) than the TAVI population (81.84 ± 5.83) (P <0.001). The SAVR group had a notably lower Society of Thoracic Surgeons (STS) score of 2.83 (SD = 2.04), whereas the TAVI patients' STS score was nearly double at 4.17 (SD= 2.21), P < 0.001. Patients undergoing TAVI had a relatively shorter average length of stay of 2.16 days (SD=1.88) than SAVR patients, which averaged at 7.11 days (SD=5.01), P < 0.001. There was no significant difference in mortality between the SAVR and TAVI patients (4 deaths in each group). There were no significant differences in complications between both SAVR and TAVI patients, except in type of arrhythmia. New onset atrial fibrillation was found in 42.9% of patients who underwent SAVR versus 0.8% in those who underwent TAVI (P<0.001). On the contrary, a new left bundle branch block was found in 14.4% of TAVI patients versus none in the SAVR patients (P<0.001). Both the type of procedure and the STS score were significant predictors for in-hospital and follow up complications in the sample.

Conclusion: This study identified several important individual characteristics, procedural details, and post-procedure factors that are associated with increased risk of in-hospital and follow up complications. The findings of this study may have implications relevant to nursing education, practice and policy making in the context of assessment of outcomes in patients undergoing aortic valve replacement.